Left coronary angiogram showing a tapering proximal total occlusion of left anterior descending (LAD) coronary artery. Left circumflex (LCX) has non flow limiting plaques in the proximal region. Distally it continues as a major obtuse marginal (OM) branch, which is free from significant disease. Reflux of contrast into the left sinus of Valsalva is seen, indicating that there is no wedging in the left main coronary artery (LMCA) of the catheter. If the catheter is wedged in the LMCA, there will be damping of catheter tip pressure on the monitor and reflux of contrast will be absent. If this is noted, further contrast injection should be avoided and the catheter withdrawn till a good pressure tracing is obtained. Injection in a wedge position in the LMCA can lead to ostial dissection and destabilization of the patient. This is a trans radial angiogram using a tiger catheter.